Provider Demographics
NPI:1912273434
Name:LOZANO, JACQUELINE R (MD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:R
Last Name:LOZANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 RETREAT AVE STE 900
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2553
Mailing Address - Country:US
Mailing Address - Phone:860-218-2245
Mailing Address - Fax:860-218-2245
Practice Address - Street 1:100 RETREAT AVE STE 900
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2553
Practice Address - Country:US
Practice Address - Phone:860-218-2245
Practice Address - Fax:860-218-2245
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283952207L00000X
390200000X
CT63947207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program